Minimally Invasive Necrosectomy versus Open Necrosectomy Approaches in a Tertiary Hepatopancreatobiliary Unit

Introduction The minimally invasive “step-up” approach to acute pancreatitis with necrotic collection is now well established. This study aimed to retrospectively review the indications, specific techniques used and outcomes of pancreatic necrosectomy in an Australasian tertiary hepatopancreatobiliary unit. Methods Retrospective analysis of 21 patients with confirmed diagnosis of necrotising pancreatitis with necrotic collection admitted to a tertiary hepatopancreatobiliary unit between May 2010 and May 2016 was performed. Primary composite endpoint of morbidity or mortality as outlined by the PANTER were examined. Results Out of the 23 total patients included in the study, 7 patients were treated with traditional open necrosectomy and the remaining 16 patients underwent a minimally invasive step-up approach. There was no statistically significant difference between the minimally invasive and open necrosectomy groups in terms of the primary endpoint (p=0.29) or development of any Grade 3 complication (p=0.19). Discussion Based on the experience of a small cohort of patients managed at a tertiary hepatopancreatobiliary unit, we did not find an appreciable difference in measurable endpoint outcomes between patients who underwent minimally invasive step-up necrosectomy as compared to open necrosectomy. Further multi-centre trials are still required to investigate if the management of severe acute pancreatitis can be safely undertaken at adequately resourced hospitals but without access to MIN.

Author(s): Eugene Wong, Julia Jones, Justin S Gundara, Christopher Nahm, Sarah Cho, Ian Norton, Jaswinder S Samra, Anubhav Mittal

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